Biomedical subjects
Publications and source records attributed to H Lohmann.
The initial care of a fractured bone provided by the general physician includes reduction followed by immobilization and the treatment of pain. Open fractures must be covered by a sterile dressing, prior to the transportation of the patient to a hospital. Depending upon the severity of the injury, further treatment is provided by an orthopedic surgeon or in an appropriate hospital.
When a fracture of an extremity has been established, the question immediately arises: should it be treated conservatively or surgically? For each of these options the three "R's" of fracture treatment apply "reduction, retention, rehabilitation". In humans, the most common fracture is that of the distal radius, which is usually amenable to conservative treatment. A fracture of the ankle is treated conservatively only when it is stable with no syndesmotic injury, and the fragments are in good alignment. Should surgical treatment be necessary, stabilization is accomplished with a plate and screws. The advantages and disadvantages of each of the options must be weighed up on an individual basis.
Hemispheric lateralization of the neural systems supporting language and spatial attention most commonly dissociate in healthy individuals. However, the reverse pattern with association of language and attention within the right hemispheres has also been observed. We investigated in 75 healthy volunteers (37 right-handed, 38 left-handed) if language and spatial attention may associate not only in individuals with an atypical pattern of language lateralization, but also in subjects showing the standard, i.e. left-hemispheric dominance for language. Hemispheric lateralization of cerebral perfusion was determined with functional transcranial Doppler ultrasonography during a visuospatial attention, and a word generation task. We found that language and visuospatial attention associated within the left hemisphere in five subjects and within the right hemisphere in eight subjects. We conclude that all combinations of cerebral lateralization for language and attention may exist in the healthy brain.
Compared to adults, children show superior recovery of language function after damage to the dominant brain hemisphere. Possible explanations are that children have different patterns of language representation or display different patterns of reorganization. Information about language lateralization in children could provide insights into the repair mechanisms of the young brain. While functional magnetic resonance imaging (fMRI) is usually difficult to perform in children younger than 5 years, functional transcranial Doppler sonography (fTCD) is nonfrightening and readily applicable in young and very young children. However, for serial examinations, sufficient validity and reliability are required. To this end, we designed a picture-description language task (PDLT) for fTCD examinations in children, compared the outcome to established protocols and determined the 1 month retest-reliability of the measurement in 16 children aged 2-9 years. The dependent variable was the task-related hemispheric perfusion difference based on averaged relative cerebral blood flow velocity (CBFV) increases in the middle cerebral arteries. This picture-description language lateralization index was compared to language lateralization by a phonetic word generation task (PWGT) in adults revealing good intermethod validity (r=0.70; P <or= 0.05). The 1 month retest-reliability of the PDLT in the children was r=0.87 (P <or= 0.05). With this degree of reliability, fTCD seems a promising tool for the assessment of changes in hemispheric involvement in language in young and very young children.
Desmoplastic fibroblastoma ("collagenous fibroma") is a benign fibrous soft tissue tumor. We report a rare case of a "collagenous fibroma" located in the proximal lower leg in 56-year-old man. The clinical, radiological, and pathological-morphological findings are documented. The operative treatment was performed according to general principles of surgical management of benign soft tissue tumors.
BACKGROUND AND PURPOSE: Transcranial Doppler sonography (TCD) can guide and complement investigations based on functional magnetic resonance and positron emission tomography imaging by providing continuous information on cerebral perfusion changes correlated to cerebral activation. So far, however, the role of functional TCD has been limited by a lack of sensitivity. METHODS: Here, the authors present an outline of a method that increases the potential of TCD to detect perfusion changes within a vascular territory. Sensitivity on the order of 1% can be achieved by transformation of Doppler envelope curves, which accounts for systemic quasi-periodic and irregular spontaneous blood flow modulations and artificial disturbances related to the recording. A statistical technique is introduced that allows the automatic detection of time periods of significant hemispheric lateralization in evoked flow studies. Furthermore, an index of laterality is defined quantifying the extent of hemispheric dominance during stimulus processing. RESULTS AND DISCUSSION: The analysis technique described in this article has been successfully employed in recent examinations on vision, motor activation, language, language recovery, and other cognitive tasks. CONCLUSION: The novel functional TCD technique permits valid and reproducible assessments of the temporal characteristics of functional hemispheric lateralization.
Amyotrophic lateral sclerosis (ALS) has traditionally been assumed to be a purely motor disturbance. It is now recognized that 2-5% of patients with ALS develop frontotemporal dementia. Additionally, neuropsychological analysis and functional imaging suggest that a proportion of patients with classical ALS also have neuropsychological impairment. On postmortem examination, ALS patients classified as not demented showed atrophy of the frontotemporal cortex. Conversely, in patients with frontotemporal dementia without known motor impairment, atrophy of spinal and bulbar neurons were found on postmortem examination. It is still not known whether patients with ALS and neuropsychological impairment form a distinct subgroup or if they are part of a continuous spectrum that runs from pure motor impairment to pure neuropsychological impairment.
BACKGROUND: Disorders of language classically occur after left brain lesions, and disorders of spatial attention after right brain lesions. It is unclear whether the hemispheric dissociation of functions is a fixed pattern of brain organization. OBJECTIVE: The authors determined whether lateralization of language and lateralization of spatial attention also dissociate in people with atypical (i.e., right hemispheric) language dominance. METHODS: The authors selected 10 subjects with typical, i.e., left hemispheric, and 10 with atypical, i.e., right hemispheric, language representation on a random basis from a sample of 326 healthy volunteers examined with functional transcranial Doppler sonography (fTCD) for language dominance. In these subjects, hemispheric lateralization of cerebral perfusion during a line bisection task was determined with fTCD. RESULTS: The authors found a dissociation between dominance for language and spatial attention in all but four subjects. In the latter subjects, there was a significant lateralization to the right hemisphere for both tasks. The four subjects showed normal intellectual, linguistic, and spatial performance, with normal EEG and MRI scans of the brain. CONCLUSION: Even in the absence of brain pathology, the same hemisphere can be dominant in control of both language and spatial attention.
In most humans, language is lateralized to the left side of the brain. It has been speculated that this hemispheric specialization is a prerequisite for the full realization of linguistic potential. Using standardized questionnaires and performance measures, we attempted to determine if there are behavioural correlates of atypical, i.e. right-hemispheric and bilateral, language lateralization. The side and degree of language lateralization were determined by measuring the hemispheric perfusion differences by functional transcranial Doppler ultrasonography during a word generation task in healthy volunteers. Subjects with left (n = 264), bilateral (n = 31) or right (n = 31) hemisphere language representation did not differ significantly with respect to mastery of foreign languages, academic achievement, artistic talents, verbal fluency or (as assessed in a representative subgroup) in intelligence or speed of linguistic processing. These findings suggest that atypical hemispheric specialization for language, i.e. right-hemisphere or bilateral specialization, is not associated with major impairments of linguistic faculties in otherwise healthy subjects.
Our knowledge about the variability of cerebral language lateralization is derived from studies of patients with brain lesions and thus possible secondary reorganization of cerebral functions. In healthy right-handed subjects 'atypical', i.e. right hemisphere language dominance, has generally been assumed to be exceedingly rare. To test this assumption we measured language lateralization in 188 healthy subjects with moderate and strong right-handedness (59% females) by a new non-invasive, quantitative technique previously validated by direct comparison with the intracarotid amobarbital procedure. During a word generation task the averaged hemispheric perfusion differences within the territories of the middle cerebral arteries were determined. (i) The natural distribution of language lateralization was found to occur along a bimodal continuum. (ii) Lateralization was equivalent in men and women. (iii) Right hemisphere dominance was found in 7.5% of subjects. These findings indicate that atypical language dominance in healthy right-handed subjects of either sex is considerably more common than previously suspected.
In most people the left hemisphere of the brain is dominant for language. Because of the increased incidence of atypical right-hemispheric language in left-handed neurological patients, a systematic association between handedness and dominance has long been suspected. To clarify the relationship between handedness and language dominance in healthy subjects, we measured lateralization directly by functional transcranial Doppler sonography in 326 healthy individuals using a word-generation task. The incidence of right-hemisphere language dominance was found to increase linearly with the degree of left-handedness, from 4% in strong right-handers (handedness = 100) to 15% in ambidextrous individuals and 27% in strong left-handers (handedness = -100). The relationship could be approximated by the formula: f1.gif" BORDER="0">. These results clearly demonstrate that the relationship between handedness and language dominance is not an artefact of cerebral pathology but a natural phenomenon.
The cerebral blood flow velocity (CBFV) in the basal arteries during a word-generation task was assessed by functional transcranial Doppler ultrasonography (fTCD) and by functional magnetic resonance imaging (fMRI). The study investigates how event-related CBFV modulations in the middle cerebral artery (MCA) relate to regional cerebral blood flow (rCBF) changes. Both fMRI and fTCD were used in 13 subjects (7 men, 6 women, aged 21 to 44 years). The maximum difference of relative CBFV changes between the left and right MCA during the word-generation task was used as the language laterality index (LIfTCD). For the fMRI examination during the nearly identical language task, the corresponding index was defined by LIfMRI = 100(N(L) - N(R))/(N(L) + N(R)), where N(L) and N(R) refer to the numbers of voxels activated in the left and right hemisphere, respectively. The evoked CBFV changes expressed by LIfTCD and the corresponding laterality index, LIfMRI, estimated by fMRI showed a close linear relation (regression analysis: r = 0.95, p < 0.0001). The results of this study demonstrate that language-related velocity changes in the MCAs relate to rCBF increases in a linear fashion. Since the laterality indices assessed by fMRI and fTCD are in such close agreement both techniques can therefore be used in a complementary way.
We investigated the activation of the brain during anticipation of tactile stimuli by continuous cerebral blood flow velocity (CBFV) monitoring with bilateral transcranial Doppler sonography. A forced choice paradigm was performed where a first group of subjects (n=16) was expecting suprathreshold and a second group (n=19) was anticipating threshold tactile stimuli to the index finger after a cueing tone. During the anticipation of suprathreshold stimuli the CBFV always exhibited a significantly stronger increase in the right hemisphere than in the left, even when stimuli were anticipated at the right index finger. Conversely when stimuli at perception threshold were expected, the respective contralateral hemisphere showed a significantly stronger perfusion increase. These data show that preparatory activation of the brain during stimulus anticipation is dependant on the expected stimulus intensity.
In most mammals the superior colliculus (SC) and the pretectal nucleus of the optic tract (NOT) receive direct input from the ipsilateral visual cortex via projection neurons from infragranular layer V. We examined whether these projection neurons belong to different populations and, if so, whether it is possible to correlate the electrophysiological features with the suggested function of these neurons. Projection cells were retrogradely labeled in vivo by rhodamine-coupled latex beads or fast blue injections into the SC or the NOT 2-5 days prior to the electrophysiological experiment. Intracellular recordings of prelabeled neurons were made from standard slice preparations and cells were filled with biocytin in order to reveal their morphology. Both cell populations consist of layer V pyramids with long apical dendrites that form terminal tufts in layer I. In electrophysiological terms, 12 of the corticotectal cells could be classified as intrinsically bursting (IB), while two neurons showed a doublet firing characteristic and one neuron was classified as regular-spiking (RS). Intracortical microstimulation of cortical layer II/III revealed that SC-projecting neurons responded optimally to stimulation sites up to a distance of 1000 microm from the recorded cell. The morphological features of the SC-projecting cells reveal an apical dendritic tuft in layer I with a lateral extension of 300 microm, a mean spine density of 65 spines per 40 microm on the apical dendrites located in layer II/III, and a bouton density of 13 boutons per 100 microm on the intracortical axons. Sixteen NOT-projecting neurons exhibited an IB and five cells an RS characteristic. Intracortical microstimulation of cortical layer II/III showed that NOT-projecting neurons responded optimally to stimulation sites up to a distance of 1500 microm. Their morphological features consist of an apical dendritic tuft with a lateral extension of 500 microm, a mean spine density of 25 spines per 40 microm on the apical dendrites located in layer II/III, and a bouton density of 6 boutons per 100 microm on the intracortical axons. When the passive membrane parameters, responses to intracortical microstimulation in layer V, the extension of the basal dendritic field, and spine densities in layers I or V were compared between SC- and NOT-projecting cells, no differences were revealed. Differences were only consistently found in the supragranular layers, either for morphological parameters or for intracortical microstimulation. The results suggest that NOT-projecting and SC-projecting neurons, although biophysically similar, could integrate and transmit different spatial aspects of cortical visual information to their target structures.
BACKGROUND AND PURPOSE: Since functional transcranial Doppler ultrasonography (fTCD) allows convenient and fully automated quantification of language lateralization, it seems ideal for longitudinal studies of perfusion changes during deterioration as well as recovery of language functions. However, during serial examinations, the technical, stochastic, and physiological variabilities of cerebral blood flow velocities (CBFV) have to be considered. Therefore, before fTCD is accepted as a tool for evaluation of changes in lateralization in the diseased state, its reliability in healthy subjects needs to be determined. METHODS: We performed fTCD during a word generation task based on a previously validated technique with automated calculation of the averaged CBFV differences in the middle cerebral arteries providing an index of lateralization (LI). RESULTS: (1) The accuracy of the LI as assessed by the confidence interval was better than 1% of the mean hemispheric difference. (2) On repeated examination, LIs obtained from 10 subjects showed a high test-retest reproducibility (Pearson product moment correlation coefficient r = 0.95, P < 0.0001). (3) On 10 repeated assessments of LI in the same subject, no practice effects were detected. CONCLUSIONS: Functional TCD is a suitable and very robust tool for the longitudinal quantitative measurement of cerebral language lateralization.
We investigated the effect of thallium ions on extracellular field potentials in the CA1 region of guinea pig hippocampal slices in a matched-pair experimental setup. Somatic and dendritic responses evoked by paired-pulse stimulation of the Schaffer collateral-commissural pathway were recorded before, during and after acute thallium exposure and compared to field potentials from nontreated control slices recorded simultaneously. Thallium reduced the orthodromically evoked population spike reversibly in a clear concentration-effect relationship. In contrast, the field excitatory postsynaptic potential fEPSP, as well as the presynaptic fiber volley of the afferent pathway, were not affected by thallium. Furthermore, the paired-pulse facilitation was reversibly reduced during thallium exposure. Input-output relations clearly demonstrated that thallium did not interfere with the presynaptic transmitter release mechanisms or the postsynaptic transmitter receptor sensitivity, but had a predominant postsynaptic target site. Additionally, any influence of thallium ions on the somatic and/or axonal membrane excitability could be excluded, as the antidromically evoked responses after alvear stimulation were not diminished by thallium. Therefore, the main effect of thallium was a decoupling of the somatic from the dendritic activity at the CA1 pyramidal cells. We conclude that the toxic influence of thallium ions in the guinea pig hippocampus must be confined to intracellular somatic mechanisms. Interactions with intracellular organelles and an impairment of their calcium storage capacity are supposed.
We investigated the spatio-temporal summation of excitatory postsynaptic potentials (EPSPs) in supragranular pyramidal cells of the rat extrastriate visual cortex. EPSPs were evoked orthodromically from different locations within the white matter (WM) via an 8-fold multi-electrode array. Stimuli were applied either sequentially from electrodes 1 to 8 or vice versa at defined interstimulus intervals (ISIs) or separately from each electrode. Maximum EPSP amplitudes were evoked from the WM just below the intracellularly recorded neuron. Even 800 microns lateral to this location, small EPSPs could be elicited. A sequential stimulation resulted in a large compound EPSP. In 79% (n = 34) of the cells tested, the compound response was non-directional and could be predicted from responses evoked by single stimulation electrodes. However, 21% (n = 9) of the neurons showed a non-linear spatial summation and a clear preference for the direction of the stimulation sequence. ISI-tuning curves revealed either a sharply tuned, a bandpass, a highpass or a lowpass characteristic for the non-directional as well as directional cells. This feature, together with the clear directional responses observed in some neurons, may be a correlate of the response preference to moving stimuli of cortical cells found in vivo.
We studied the development and spatial organization of vertically arranged pyramidal dendritic and axonal bundles in the visual cortex of the rat by using extracellular biocytin injections into frontal brain slice preparations. Vertical bundles of intracortical axons could be clearly observed at time of birth with a initial center-to-center distance of 18 microns +/- 3.1 microns. At the same time a clustering of pyramidal cell apical dendrites was completely absent. Dendritic bundles were demonstrated for the first time at postnatal day 5 when the supragranular layer 2/3 begins to differentiate. In the following weeks both axonal as well as dendritic bundles grew continuously and completely in parallel with regard to their center-to-center distances, diameters and number of elements up to their adult values at around postnatal day 90. At adulthood both types of bundles showed a center-to-center distance of 50.1 microns +/- 20.1 microns (axons) and 52.6 microns +/- 18.1 microns (dendrites), respectively. Our results demonstrate that axonal and dendritic bundles originating from the same neurons in the visual cortex of the rat correspond very well with regard to their size and distances. Developing neurons migrating along radial glia fibers group their axons together in fascicles before the lamination of the cortex is completely matured. After all layers have been developed, the apical dendrites of pyramidal cells with aggregated axons also group in clusters. The following development of axonal and dendritic bundles is presumably concerned with the volume increase of the maturating neocortex. Evidence for activity dependent plasticity after eye opening could not be found.